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    I struggled in clinical practice

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    I felt lost, confused, and useless. 

    Six years ago, I had a lovely 50 year old woman sitting in front of me complaining of shortness of breath. It was my first day rotating through a busy emergency department. 

    As I asked the patient questions – my mind went blank… 

    I inquired about her past medical history and was able to do a basic review of systems. She answered my questions, but I had no idea how to put it all together. I didn’t know what the next step in management was.

    Before this rotation, I felt prepared. I studied my ass off. But, that day, the knowledge was nowhere to be found. 

    I presented my findings to the resident. He listened to what I had to say and then proceeded to ask me what we should do next. I didn’t have a clue. 

    So, he walked over to the patient, asked about chest pain, dyspnea on exertion, and orthopnea. He noticed she was obese, had bilateral pitting edema, and heard crackles on auscultation. 

    She was clearly having an acute CHF exacerbation 🙈

    Now, this wasn’t a rare disease and this was definitely something I had studied before. 

    Although I read about the disease – I never actually saw it presenting in a real life patient. The fast pace of the emergency department also left me overwhelmed. 

    So, as you can imagine, I felt lost, confused, and useless. 

    It’s one thing to read about it and it’s something completely different to see it. Why? Because as a new graduate and/or a student first starting rotations – we have so many other things we need to worry about. We have more to do than to simply make a diagnosis.

    There are a ton of other factors that come into play which can make our life difficult. A ton of other factors, which quite frankly, we don’t really learn in school.

    But, I went home that day, and spent hours studying CHF. I made it a point to never miss another CHF diagnosis again. The reality is, you’ll never know it all. So, things like this will always happen.

    It doesn’t matter how smart you are or how long you’ve been in the game – there will still be patients that stump you. Granted, it won’t be the simple CHF case – but there will always be cases with increasing levels of complexity that occur to which you’ve never been exposed to. 

    Understanding you will never know everything is what makes our profession both beautiful yet problematic. It’s a love-hate relationship. 

    This should excite and motivate you to continuously better yourself. 

    Just as I look back and realize how far I’ve come – you too will do the same. The progress might be slow and insidious, but it will be progress nonetheless. 

    My advice to you, if you’re just starting out, is to try and find a mentor. This way, the learning curve won’t be as steep. Because, there are tricks of the trade, which will make your life easier 🤓

    Talk soon.

    Andrew
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